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An exception request is a type of coverage determination. An enrollee, an enrollees prescriber, or an enrollees representative may request a tiering exception or a formulary exception.
What is an exception request in health insurance?
You can get an exemption so that you wont have to pay a penalty for not having qualifying health insurance. Some exemptions require an exemption application through Covered California. Other exemptions do not require an application: Instead, you can claim them when you file your state tax return.
Does Navitus cover Wegovy for weight loss?
Certain weight loss medications are not required to be covered and Wegovy is not currently covered. What conditions / drugs commonly required prior authorization or step therapy? Call Navitus at 1.866.
What is the exception to coverage in Navitus?
The Exception to Coverage (ETC) process allows members to request coverage of medications that show formulary restrictions. The ETC form cannot be used to request copay lowering or coverage of a direct plan exclusion.
What is an exception to coverage?
An exception request is a type of appeal that you can file with your health insurance company when a medication is not covered on the list of drugs covered by your plan, also known as a formulary.
Navitus Health Solutions, owned by SSM Health and Costco Wholesale Corporation, was founded in 2003 as an alternative to traditional pharmacy benefit manager (PBM) models. Navitus approaches pharmacy services fundamentally differently.
Related links
Pharmacy Benefit Manager (PBM) FAQs | ETF
If you cannot take the generic drug for medical reasons, your doctor will have to request an exception to coverage from Navitus. Some doctors write
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